Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROVERA/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633778
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PROVERA/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633778
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROVERA/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633777
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

PROVERA/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60633777
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

PROVIGIL 100MG

Facility

$6.00

Hospital Charge Code	60635497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

PROVIGIL 100MG

Facility

$6.00

Hospital Charge Code	60635497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

PRO VISC 0.85ml 8065-183085

Facility

$337.35

Hospital Charge Code	270636748
Hospital Revenue Code	272
Min. Negotiated Rate	$50.60
Max. Negotiated Rate	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$50.60

PRO VISC 0.85ml 8065-183085

Facility

$337.35

Hospital Charge Code	270636748
Hospital Revenue Code	272
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$168.68
Rate for Payer: Aetna Commercial	$128.19
Rate for Payer: Aetna Medicare Advantage	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.02
Rate for Payer: Cigna Commercial	$168.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.20
Rate for Payer: Oxford Commercial	$67.47
Rate for Payer: Qualcare PPO/HMO/WC	$50.60
Rate for Payer: UnitedHealthcare Commercial	$67.47
Rate for Payer: UnitedHealthcare Community & State	$8.13
Rate for Payer: Wellpoint Medicaid Managed Care	$8.94

PROVISC 8065-183055

Facility

$215.00

Hospital Charge Code	270640127
Hospital Revenue Code	272
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$43.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$43.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

PROVISC 8065-183055

Facility

$215.00

Hospital Charge Code	270640127
Hospital Revenue Code	272
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

PROVISC INJ 10MG/.85ML SY

Facility

$1,471.86

Service Code	NDC 8065183085
Hospital Charge Code	60635662
Hospital Revenue Code	250
Min. Negotiated Rate	$35.47
Max. Negotiated Rate	$735.93
Rate for Payer: Aetna Commercial	$559.31
Rate for Payer: Aetna Medicare Advantage	$441.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.32
Rate for Payer: Cigna Commercial	$735.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.56
Rate for Payer: Oxford Commercial	$294.37
Rate for Payer: Qualcare PPO/HMO/WC	$220.78
Rate for Payer: UnitedHealthcare Commercial	$294.37
Rate for Payer: UnitedHealthcare Community & State	$35.47
Rate for Payer: Wellpoint Medicaid Managed Care	$39.00

PROVISC INJ 10MG/.85ML SY

Facility

$1,471.86

Service Code	NDC 8065183085
Hospital Charge Code	60635662
Hospital Revenue Code	250
Min. Negotiated Rate	$220.78
Max. Negotiated Rate	$220.78
Rate for Payer: Qualcare PPO/HMO/WC	$220.78

PROVOX EXTRAFLOW HME(30 PCS)

Facility

$490.00

Hospital Charge Code	270688076
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$107.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

PROVOX EXTRAFLOW HME(30 PCS)

Facility

$490.00

Hospital Charge Code	270688076
Hospital Revenue Code	278
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$107.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Community & State	$11.81
Rate for Payer: Wellpoint Medicaid Managed Care	$12.98

PROVOX LARYTUBE 10/55

Facility

$632.50

Hospital Charge Code	270688077
Hospital Revenue Code	272
Min. Negotiated Rate	$15.24
Max. Negotiated Rate	$316.25
Rate for Payer: Aetna Commercial	$240.35
Rate for Payer: Aetna Medicare Advantage	$189.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.29
Rate for Payer: Cigna Commercial	$316.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.75
Rate for Payer: Oxford Commercial	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$94.88
Rate for Payer: UnitedHealthcare Commercial	$126.50
Rate for Payer: UnitedHealthcare Community & State	$15.24
Rate for Payer: Wellpoint Medicaid Managed Care	$16.76

PROVOX LARYTUBE 10/55

Facility

$632.50

Hospital Charge Code	270688077
Hospital Revenue Code	272
Min. Negotiated Rate	$94.88
Max. Negotiated Rate	$94.88
Rate for Payer: Qualcare PPO/HMO/WC	$94.88

PROVOX SHOWER AID

Facility

$195.00

Hospital Charge Code	270688075
Hospital Revenue Code	272
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

PROVOX SHOWER AID

Facility

$195.00

Hospital Charge Code	270688075
Hospital Revenue Code	272
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

PROVOX TUBEBRUSH 12MM (6 PCS)

Facility

$222.50

Hospital Charge Code	270688078
Hospital Revenue Code	272
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$111.25
Rate for Payer: Aetna Commercial	$84.55
Rate for Payer: Aetna Medicare Advantage	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.74
Rate for Payer: Cigna Commercial	$111.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.75
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.38
Rate for Payer: UnitedHealthcare Commercial	$44.50
Rate for Payer: UnitedHealthcare Community & State	$5.36
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

PROVOX TUBEBRUSH 12MM (6 PCS)

Facility

$222.50

Hospital Charge Code	270688078
Hospital Revenue Code	272
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$33.38
Rate for Payer: Qualcare PPO/HMO/WC	$33.38

PROVOX TUBEHOLDER

Facility

$110.00

Hospital Charge Code	270688079
Hospital Revenue Code	272
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

PROVOX TUBEHOLDER

Facility

$110.00

Hospital Charge Code	270688079
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

PROVOX VEGA PUNCTURE SET

Facility

$1,895.00

Hospital Charge Code	270688080
Hospital Revenue Code	272
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

PROVOX VEGA PUNCTURE SET

Facility

$1,895.00

Hospital Charge Code	270688080
Hospital Revenue Code	272
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$947.50
Rate for Payer: Aetna Commercial	$720.10
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.50
Rate for Payer: Oxford Commercial	$379.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$379.00
Rate for Payer: UnitedHealthcare Community & State	$45.67
Rate for Payer: Wellpoint Medicaid Managed Care	$50.22

PROXIMAL HUMERAL PLATE 3.5MM

Facility

$31,914.40

Service Code	HCPCS C1713
Hospital Charge Code	270705122
Hospital Revenue Code	278
Min. Negotiated Rate	$769.14
Max. Negotiated Rate	$15,957.20
Rate for Payer: Aetna Commercial	$12,127.47
Rate for Payer: Aetna Medicare Advantage	$9,574.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,138.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,138.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,382.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,138.17
Rate for Payer: Cigna Commercial	$15,957.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,723.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,021.17
Rate for Payer: Qualcare PPO/HMO/WC	$4,787.16
Rate for Payer: UnitedHealthcare Community & State	$769.14
Rate for Payer: Wellpoint Medicaid Managed Care	$845.73

Know your out-of-pocket cost for care.

All Charges